원시굴절부등을 동반한 굴절조절내사시의 임상양상
Clinical Features of Refractive Accommodative Esotropia with Hyperopic Anisometropia
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목적: 원시굴절부등을 동반한 굴절조절내사시의 임상양상에 대하여 알아보았다. 대상과 방법: 굴절조절내사시 환아 71명을 대상으로 굴절부등의 유무에 따라 대조군과 굴절부등군으로 나누고, 굴절부등군은 다시 부등시소실군과 유지군으로 분류하여 각 군의 굴절값, 약시, 입체시, 대상부전, 안경 벗음 등의 임상양상을 비교하였다. 결과: 굴절조절내사시 71명 중 원시굴절부등은 14명(19.7%)에서 관찰되었으며, 약시는 초진 시에 대조군 35%, 굴절부등군 67%로 굴절부등군에서 더 많았으나(p=0.048), 최종경과 시에는 두 군간에 차이 없이 호전되었다. 티트무스검사에서 100초보다 좋은 입체시를보인 경우는 초진 시에 대조군 28%, 굴절부등군 21%, 최종경과 시에 대조군 67%, 굴절부등군 79%로 두 군 간에 차이 없이 모두 호전되었다. 대상부전, 안경 벗음도 두 군간에 차이가 없었다. 최종경과 시 부등시가 소실된 경우는 43%로, 부등시소실군과 유지군 간에약시, 입체시, 대상부전, 안경 벗음 등은 차이가 없었다. 결론: 굴절조절내사시에서 원시굴절부등으로 인한 약시를 가진 경우라도 안경교정, 가림치료 등을 통해 좋은 치료효과를 기대해 볼수 있다.
Abstract
Purpose: To investigate the clinical features of refractive accommodative esotropia with hyperopic anisometropia. Methods: Retrospective chart review was performed for 71 patients with refractive accommodative esotropia and hyperopic anisometropia. Patients were divided into isometropia and anisometropia groups, as well as disappeared anisometropia and maintained anisometropia groups. Clinical features such as amblyopia, stereopsis, decompensation, and cessation of spectacle use were reviewed. Results: Anisometropia was found in 14 patients (19.7%). Amblyopia was detected in 35% of the patients in the isometropia group and 67% of the patients in the anisometropia group on the first visit (p = 0.048), but improved to 14% in the isometropia group and 21% in the anisometropia group on the final visit. Good stereopsis was reported in 28% of the patients in the isometropia group and 21% of the patients in the anisometropia group on the first visit, and improved to 67%in the isometropia group and 79% in the anisometropia group on the final visit. There were no differences of prevalence of decompensation and cessation of spectacle use between the 2 groups. Cases with disappeared anisometropia on the final visit were observed in 42.9% of the patients. Disappearance of anisometropia was not related with amblyopia, stereopsis,decompensation, and cessation of spectacle use. Conclusions: Although refractive accommodative esotropia accompanied by anisometropia has a greater chance to show amblyopia on the initial visit, good prognosis can be expected when the patients are carefully managed with hyperopic correction and occlusion therapy.
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